Stroke is a common health problem which may cause long-term and ethically
challenging changes in the lives of individuals with stroke (IwS). The study focused
on the realization of central values in nursing practice as perceived by IwS and the
potential changes in the perceived realization of values in post-stroke time, labeled
as the ethical pathway. The main aim was to compose a theoretical construct of the
ethical pathway. The ultimate goal was, by making the ethical pathway visible, to
support the development and realization of ethically high-level nursing care.

The study was conducted in four steps. In the first step, based on a grounded
theory study (n = 16 IwS) and scoping literature review (n = 15), the concept ‘ethical
pathway’ and the life situational factors related to it were defined. In the second step,
they were operationalized, leading to the Ethical Pathway of Individuals with Stroke
(EPIS) instrument evaluating the realization of values and life situational factors in
post-stroke time as perceived by IwS. In the third step, the concept of the ethical
pathway and its association with the life situational factors were empirically tested
in a cross-sectional study (n = 61 IwS) and a follow-up study (n = 36 IwS). In the
fourth step, the obtained results were synthesized to form the theoretical construct of
the ethical pathway.

The concept of the ethical pathway was defined as potential changes in the
realization of values, including dignity, privacy, and autonomy, as perceived by
individuals in temporal passage. The life situational factors related to the ethical
pathway were defined as symptoms diminishing functioning, social environment,
and self-empowerment. The theoretical construction of the ethical pathway consists
of the concept of the ethical pathway and the life situational factors, and the
association between these. As changes in the individual’s health status may change
the perceived realization values, health status is also represented in the theoretical
construction of the ethical pathway. The ethical pathway is dynamic, and the
association between the ethical pathway and the life situational factors fluctuates in
temporal passage. In this study, the ethical pathway was made visible, and by
understanding the ethical pathway, nurses may support the perceived realization of
individuals’ values during the care pathways.